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General NPI Number Information
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NPI Number | 1427441476
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Entity Type | Organization
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Legal Business Name | DRAKE DENTAL CARE PROFESSIONALS, LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 140 BOARDWALK DR UNIT G
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City | FORT COLLINS
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State | CO
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Zip | 80525-3153
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Country | US
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Telephone | 970-407-8080
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Fax | 970-221-3590
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Provider Business Mailing Address
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Address Line | 140 BOARDWALK DR UNIT G
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City | FORT COLLINS
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State | CO
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Zip | 80525-3153
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Country | US
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Telephone | 970-407-8080
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Fax | 970-221-3590
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD SCOTT WUERKER
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Credential | D,D,S,
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Telephone | 970-407-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6693
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License Number State | CO
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